editorNPR Digital Services RSS Generator 0.94John Henning Schumann, M.D., is an internal medicine physician and writer (http://glasshospital.com). He has contributed to Slate, The Atlantic, Marketplace, and National Public Radio’s health blog, Shots.Schumann serves as guest host for Studio Tulsaon health-related themes and is also host of Medical Matters on KWGS, an occasional series about health care and the human condition.He was appointed Interim President of the University of Oklahoma – Tulsa in January 2015. You can find him on twitter @GlassHospital.NPR Digital Services RSS Generator 0.94John Henning SchumannSun, 02 Oct 2016 12:31:49 +0000John Henning Schumannhttp://krwg.org
John Henning SchumannPeople might be forgiven for thinking that the Affordable Care Act is the federal government's boldest intrusion into the private business of health care.But few know about a 70-year-old law that is responsible for the construction of much of our health system's infrastructure. The law's latest anniversary came and went without much notice in August.The Hill-Burton Act was signed into law by President Harry S. Truman on August 13, 1946 — and its effect on health care in the U.S. was nothing short of monumental. Perhaps more importantly, it stands as an example, warts and all, of how a bipartisan Congress can forge compromises to bolster American infrastructure and boost the well-being of our people.Known formally as the Hospital Survey and Construction Act, Hill-Burton started as a Truman initiative. In November 1945, only two months after the official end of World War II, he gave a speech to Congress outlining five goals to improve the nation's health. The first and leastA Bygone Era: When Bipartisanship Led To Health Care Transformationhttp://krwg.org/post/bygone-era-when-bipartisanship-led-health-care-transformation
123604 as http://krwg.orgSun, 02 Oct 2016 10:00:00 +0000A Bygone Era: When Bipartisanship Led To Health Care TransformationJohn Henning SchumannFor years, Mrs. Sutton came to see me in the office every three months. Visiting the doctor quarterly was "the right thing to do," she told me, given the fact that she had both diabetes and high blood pressure.She always set the agenda at our visits. She brought lists of questions and requests that followed the recommendations of her fellow churchgoers and the health materials she had read.It came as no surprise to me when she asked to undergo a colonoscopy at age 68, in order to be screened for colon cancer. She had read that colon cancer was treatable if caught early, and several friends had told her that undergoing "the scope" was the most comprehensive means of screening.I agreed that it was a good idea and dutifully made the referral to the gastroenterologist. When the report came back a few weeks later, I was pleased to learn there were no polyps found.When I mentioned the test to Mrs. Sutton at our next visit, I assumed she'd be as happy with the results as I had been. Instead,Why Doctors Need To Have Answers For Patients' Questions About Costs http://krwg.org/post/why-doctors-need-have-answers-patients-questions-about-costs
106760 as http://krwg.orgSat, 16 Jan 2016 10:54:00 +0000Why Doctors Need To Have Answers For Patients' Questions About Costs John Henning SchumannIf you follow health news, by now you may have heard about a federally funded study that was stopped early because of impressive evidence that aggressively lowering blood pressure saves lives.For more than half a century we've known that controlling blood pressure (getting the numbers below 140/90) is important in preventing heart attacks, strokes and kidney failure. The so-called SPRINT study that was just stopped tells us that lowering the systolic blood pressure (the top number) to 120 or lower is even better in preventing complications and death from cardiovascular causes.While we wait for the study details to be published in a medical journal, the news about the study has given me pause. How low should we go and for how long?I think about a patient of mine in his 80s. For decades, he's taken a combination pill (two medicines in one) to keep his blood pressure below 140/90. Six months ago, he told me that he'd been having episodes of lightheadedness once or twice a week. That's aPruning Back Prescriptions For Better Healthhttp://krwg.org/post/pruning-back-prescriptions-better-health
99488 as http://krwg.orgSun, 27 Sep 2015 15:40:00 +0000Pruning Back Prescriptions For Better HealthJohn Henning SchumannBeware the mention of natural causes, as in my mother's obituary:"Norita Wyse Berman, a writer, stockbroker and artist ... died at home Friday of natural causes. She was 60."Sixty-year-olds don't die of natural causes anymore. The truth was too hard to admit.Fifteen years on, I'm ashamed of my family's shame. Those attending her funeral and paying shiva calls knew the truth anyway. People talk.One of the many ironies of dying young is that my mother was a true believer in modern medicine. She had a cabinet full of elixirs and potions for which she paid top dollar. For most of her life she never paid retail for anything, so the medicine cabinet was testament to her insecurity about fleeting beauty and a quest for longevity. Others around her might succumb to aging, but my mom had confidence that her vitamins and nutraceuticals could hold back Father Time.Her anxieties predated the Internet and the rise of Dr. Oz. I know she'd have become a big fan of the telegenic surgeon, and wouldNo Shame, No Euphemism: Suicide Isn't A Natural Cause Of Deathhttp://krwg.org/post/no-shame-no-euphemism-suicide-isnt-natural-cause-death
95672 as http://krwg.orgSat, 01 Aug 2015 11:03:00 +0000No Shame, No Euphemism: Suicide Isn't A Natural Cause Of DeathJohn Henning SchumannFamed doctor and medical educator William Osler once said, "A physician who treats himself has a fool for a patient."What, I wonder, does that say about us doctors who treat our own kids?This past winter, my daughter got the flu. She was miserable: daily fevers, achiness, sore throat, stuffy head and nausea with a total loss of appetite.We didn't run a flu test on her, which you can do with a quick nasal swab at a doctor's office. Since my wife and I are both docs, we were comfortable that her symptoms fit the diagnosis.Our feeling was that the illness would run its course. There isn't a whole lot you can do for the flu. Tamiflu gets plenty of hype, but it's no panacea. The most important thing is to get plenty of rest and make sure you keep your body hydrated enough to combat the fevers.Eventually, both my wife and I started to worry our kiddo wasn't able to keep up with the necessary hydration. On the fifth day, we decided it might be worth taking her to the doctor, just to get herWhat Could Go Wrong When Doctors Treat Their Own Kids?http://krwg.org/post/what-could-go-wrong-when-doctors-treat-their-own-kids
88385 as http://krwg.orgSun, 12 Apr 2015 12:03:00 +0000What Could Go Wrong When Doctors Treat Their Own Kids?John Henning SchumannOscar buzz surrounds Julianne Moore for her role as Alice Howland in the film Still Alice. Howland is a linguistics professor who develops early-onset Alzheimer's, a cruel irony for a character who makes her living with her brain.Howland's awareness of her fate makes her decline all the more painful to watch.Often, though, patients and their doctors can be slow to recognize dementia, which most often progresses gradually.Patients can be all over the spectrum with regard to age-related decline in memory. At what point does mild cognitive impairment progress to outright dementia?Like a retired cop who was 73 when he came under my care. He had high blood pressure, Type 2 diabetes and high cholesterol. All were under control with the help of medicines he was good about taking.Here's how our typical visit would go."Any problems today?" I would ask."Nope," he would answer. "Everything's fine."During our first visit he told me that he was an early morning mall-walker, part of an exerciseWhen A Patient Says 'Everything's Fine,' A Doctor Should Be Wary http://krwg.org/post/when-patient-says-everythings-fine-doctor-should-be-wary
84647 as http://krwg.orgSun, 15 Feb 2015 10:45:00 +0000When A Patient Says 'Everything's Fine,' A Doctor Should Be Wary John Henning SchumannThe holidays are here, bringing joy and, for some, wistful feelings.Doctors are no different. Even for a profession that prides itself on scientific proof, the long nights of December afford ample opportunity for reflection and even doubt.As we take stock of what we've accomplished and where we've failed to measure up, I find my scowling mask of medical skepticism falling away. I have to admit that there is so much wonder and mystery that science and medicine still can't explain.Take Evelyn. Now in her late 70s, she has survived more than five years with advanced multiple myeloma, a kind of blood cancer. When her cancer was discovered, she agreed to undergo the usual chemotherapy treatment. At first it went well, shrinking her tumors and improving her blood counts.But after her second round of treatment, her legs started swelling, her nerves began to burn, and she rapidly lost weight. Her ability to care for herself dwindled. She chose to forgo further cancer treatment. The cancerWonder Abides, Even For A Skeptical Doctor http://krwg.org/post/wonder-abides-even-skeptical-doctor
81303 as http://krwg.orgSun, 28 Dec 2014 10:36:00 +0000Wonder Abides, Even For A Skeptical Doctor John Henning SchumannMaybe you've heard about the slow food movement. Maybe you're a devotee.The idea is that cooking, nutrition and eating should be intentional, mindful and substantive. Avoid fast food and highly processed grub. For the slow food set, the process is as important as the product.Now I'm seeing a medical version of slow food. The concept is bubbling up in response to industrialized, hypertechnological and often unnecessary medical care that drives up costs and leaves both doctors and patients frazzled.As a teacher of medical students and residents, I find myself pulled between two contradictory poles. I want new doctors to be efficient so that they can survive in the real world of medical practice, which breaks our time into eight-minute increments. But I also want them to take the time to think through their actions and consider potential consequences.Slow medicine adherents will be quick to tell you that the vast majority of CT scans ordered in emergency departments are of little value,If Slow Is Good For Food, Why Not Medicine?http://krwg.org/post/if-slow-good-food-why-not-medicine
79925 as http://krwg.orgSun, 07 Dec 2014 10:20:00 +0000If Slow Is Good For Food, Why Not Medicine?John Henning SchumannBack in 2003 I was a junior doctor working at a Chicago teaching hospital.As one of the newer docs, my daily appointment schedule had lots of openings. Pretty much any assignment nobody else wanted came my way.One morning the nurse who managed our clinic told me that my first patient for the afternoon may have been exposed to a deadly virus while he was traveling in Asia.My job would be to dress up in a medical hazmat suit, examine him and figure out whether he should be quarantined.I didn't have much of an appetite for lunch that day, despite feeling like it might be my last meal.At the time, Severe Acute Respiratory Syndrome was killing people, mostly in China. Travel alerts were all over the TV and radio. People, especially air travellers, started wearing surgical masks in public. There were worries that the full extent of the new illness was being concealed by Chinese authorities. Deep skepticism about the country's slow-footed response contributed to a sense overall panic.The SARSWhat A Brush With SARS Taught A Doctor About Ebolahttp://krwg.org/post/what-brush-sars-taught-doctor-about-ebola
77539 as http://krwg.orgThu, 30 Oct 2014 18:53:00 +0000What A Brush With SARS Taught A Doctor About EbolaJohn Henning SchumannExecutions in this country often draw controversy. But when the headlines about them include words like botched or bungled, the debate about capital punishment enters new territory.In Oklahoma, where I practice medicine, Clayton Lockett was convicted of murdering Stephanie Nieman, who had just graduated from high school, in 1999. Testimony revealed that Lockett bound her hands and mouth with duct tape, shot her twice and buried her alive in a roadside grave. He was convicted of first degree murder in 2000.After a legal odyssey involving both the state's Supreme Court and the governor issuing stays on the planned execution, a lethal injection was eventually scheduled. But there are shortages of sodium thiopental and pentobarbital, anesthetics that have been used for lethal injections. European manufacturers have discontinued or limited production based on the European Union's proscription of the death penalty.Without either of these drugs available to render prisoners unconscious,Botched Execution Leads Doctor To Review His Principleshttp://krwg.org/post/botched-execution-leads-doctor-review-his-principles
65195 as http://krwg.orgWed, 30 Apr 2014 21:35:00 +0000Botched Execution Leads Doctor To Review His PrinciplesJohn Henning SchumannI pulled back the curtain, ready to meet the next patient on my hospital rounds."Why are you standing there?" she asked me. "Come, have a seat, let's talk."Lenore could have been my grandmother. She was 77 years old, and all of 93 pounds. What she lacked in girth, she more than made up for in chutzpah. She was one of the patients from intern year who I'll never forget.After four years of medical school, I could recite biochemical pathways, genetic mutations and the ways all sorts of drugs work. But all the cramming suppressed most of my common sense. Perhaps manners, too.Lenore was offering me a refresher course. How could I refuse her polite but firm invitation?I'd never been encouraged to sit at a patient's bedside — to stop hurrying for even a moment.Our medical teachers put a premium on accuracy and efficiency, which became conflated with speed. Everything had to be fast.In 2014, doctors still value speed and technical accuracy, but we also do more to consider the quality of care5 Simple Habits Can Help Doctors Connect With Patientshttp://krwg.org/post/5-simple-habits-can-help-doctors-connect-patients
57615 as http://krwg.orgSat, 11 Jan 2014 18:52:00 +00005 Simple Habits Can Help Doctors Connect With PatientsJohn Henning SchumannDecember is supposed to be the time of year filled with family gatherings and holiday good cheer. For medical residents, quite the opposite is true.There are no school breaks during residency. Being a medical resident is a real job, and a stressful one at that. Residents work long shifts, even with caps that max out at 16 hours for the newbies and up to 28 hours for those beyond the first year.For many of our trainees — especially those fresh out of medical school — this will be the first holiday season without time off.It's well-known among residency program directors like me that interns, trainees in their first year, enter the doldrums as daylight wanes and they have to come to and leave the hospital in cold darkness.At holiday time, interns are approaching the midpoint of their year. That's long enough to feel committed to their chosen path but not nearly far enough along to see the finish line's banners. Doubts amplify.Combine the low emotional ebb with the knowledge that more ofFor 2 Young Doctors, Working On Christmas Was A Privilegehttp://krwg.org/post/two-young-doctors-working-christmas-was-privilege
56391 as http://krwg.orgSun, 22 Dec 2013 11:10:00 +0000For 2 Young Doctors, Working On Christmas Was A PrivilegeJohn Henning SchumannA 40-something patient I'll call Ted has a list of conditions that would have tongue-tied Carl Sagan. Even though I see Ted in my clinic every month, he still winds up visiting the emergency room 20 times per year.Yes, 20.Before he became my patient, he went even more frequently. So, the current situation, bad as it may be, represents halting progress.Inside the hospital, Ted is what's known as a frequent flier, a patient we see over and over again. Unlike airlines, hospitals don't offer people like Ted perks or first class upgrades. In fact, they often get worse customer service, like the apocryphal boy who cried, "Wolf!"Patients like Ted attract a lot of attention from hospital administrators and health policy wonks. Ted's on Medicaid. And he's a heavy user of health services. Recent Medicaid data show that the top 5 percent of patients account for more than half of all Medicaid spending.Intuition says if we can improve the health of frequent fliers then we stand to reduce our nationWhy Can't Ted Stay Out Of The Emergency Room?http://krwg.org/post/why-cant-ted-stay-out-emergency-room
53592 as http://krwg.orgSun, 10 Nov 2013 20:07:00 +0000Why Can't Ted Stay Out Of The Emergency Room?John Henning SchumannDebate is raging about Obamacare, and not just in Washington. Out here in Oklahoma we're grappling with implementation of the Affordable Care Act. Patients. Employers. Hospitals. Doctors. Insurers. All of us.Here then are one doctor's predictions about what we will see in the short and medium term for what I see as the unfolding Obamacare era — the biggest domestic health expansion since the enactment of Medicare in 1965.1. Obamacare is moving ahead, Texas Republican Sen. Ted Cruz notwithstanding. Too many organizations, both inside and outside the government, have invested too much time and money to stop or reverse Obamacare's changes. We will look back on these defunding attempts as political theater.2. Medicine has entered the era of big data. You'll be nudged regularly by your doctor, other health care providers or so-called medical homes to obtain recommended tests like mammograms, colonoscopies and vaccinations. Health plans will use statistics on flu shots administered and otherA Doctor's 9 Predictions About The 'Obamacare Era'http://krwg.org/post/doctors-9-predictions-about-obamacare-era
50855 as http://krwg.orgMon, 30 Sep 2013 21:17:00 +0000A Doctor's 9 Predictions About The 'Obamacare Era'John Henning SchumannI became a doctor to help people.When I was a medical student, I held the naive and idealistic belief that if I just did good work, the business side of things would somehow take care of itself.How wrong I was.Now I'm an internist taking care of all comers age 18 and up. Some days I find myself facing patients and feeling more like a harried airline clerk than a real doctor.I carry a laptop in and out of each exam room, fretting about entering all sorts of data to document the work I do. It feels as though I'm trying to find seats on an oversold airplane — and someone's going to leave the office unhappy toward the end of the day as all the computer work leads to overtime.Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place.It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand.Government incentives that are pushing us toward computer-based records mean thatDoctors Look For A Way Off The Medical Hamster Wheelhttp://krwg.org/post/doctors-look-way-medical-hamster-wheel
47514 as http://krwg.orgWed, 14 Aug 2013 13:34:00 +0000Doctors Look For A Way Off The Medical Hamster WheelJohn Henning SchumannEven if I hadn't known the hospital inspectors were coming, I would have figured it out quickly enough from my email.The admonitions were flying:"Know your safety protocols backwards and forwards!""Sign things legibly, or at the very least print your name below the signature.""Wash your hands before and after patient contact. (The surveyors will be watching .... )"It's boilerplate stuff that doctors like me should do all the time but often overlook.Now we were about to be graded. Hospitals that the quality inspectors deem deficient can lose their accreditation and be barred from Medicare reimbursement.A nonprofit called the Joint Commission, though not on the tip of patients' tongues, is the outfit we're accustomed to seeing every three years for these quality checkups.So I was surprised to learn that the surveyors, as they like to be called, were coming instead from a Norwegian company called DNV, that's short for Det Norske Veritas, or, in English, "The Norwegian Truth."The companyIt Came From Norway To Take On A Medical Goliathhttp://krwg.org/post/it-came-norway-take-medical-goliath
40867 as http://krwg.orgFri, 10 May 2013 14:16:00 +0000It Came From Norway To Take On A Medical Goliath